In July 2016, President Obama signed into law The Comprehensive Addiction and Recovery Act (CARA). This sweeping legislation was the product of several years of input from hundreds of advocates within the addiction community. CARA establishes a coordinated and comprehensive strategy through enhanced grant programs. These grant programs expand prevention and education efforts and promote treatment and recovery.
In the news right now, there is a bill in Congress called CARA 2.0 Act of 2018. CARA 2.0 builds on the original CARA by introducing new rules, adds funding to new and existing programs, and proposes six new policies. Legislators have amended some of the key parts of this bill to help fight the opioid epidemic. When Congress says they are amending a bill that means they are adding or removing different parts in order to get this bill passed or to make a current bill more effective. They usually add ideas from their constituents too. Who are their constituents? You are! That is why it is very important to make your voice heard to your state representative about these issues.
In this article, I will break down the most important areas of the bill. I think is important for you to understand how our laws, including proposed laws, affect people who are in or seeking long-term recovery. The purpose of the Champion's
Corner is to keep you informed and to educate. So let’s dive in to this bill!
There are five key issues of CARA 2.0 that I believe are the most important. I am listing them in no particular order because I feel they are all equally important to the recovery community.
Impose three-day limits- This bill will limit initial opioid prescriptions for the treatment of acute pain to three days. Long-term opioid dependence is associated with acute use, and greater exposure is a greater risk. Consistent with the CDC Guidelines for Prescribing Opioids, this requirement means that clinicians will prescribe the lowest effective dose of opioids needed when pain is severe enough to require them, reducing the risk of long-term use and potential dependence. This includes exemptions for medical necessity, including the treatment of chronic pain, cancer, opioid use disorder, and hospice.
Use medication to assist treatment- CARA 2.0 will permanently allow physician assistants and nurse practitioners to prescribe buprenorphine under the direction of a qualified physician, which was temporality authorized in the original CARA law. It will also allow states to waive the limit on the number of patients a physician can treat with buprenorphine (there are currently caps of between 30-275 patients per prescriber). Additionally, it will authorize $300 million to expand medication-assisted treatment, up from $25 million in the original law. Buprenorphine are office-based opioid agonist/ antagonist that blocks other narcotics while reducing withdrawal risk; daily dissolving tablet, cheek film, or 6-month implant under the skin. There are different types of medications they can use to help fight the addiction, they are Methadone, Naltrexone, and Buprenorphine.
Require the use of PDMPs- The proposal would require practitioners and pharmacists to use their state’s Prescription Drug Monitoring Programs (PDMP) within one year of enactment. These are the electronic databases that keep a record of the prescriptions doctors and other prescribers write for controlled substances. The bill will require practitioners to first check the PDMP before prescribing a controlled substance, and then check again every 3 months during the treatment. It will also require proactive notifications to the practitioner when high-risk patterns are detected, and for states to make data available to necessary agencies and to other states.
Train first responders- It authorizes $300 million annually to train first responders on safety around fentanyl and other dangerous illicit substances. Fentanyl is 50 to 100 times more potent than morphine, and is driving overdose deaths around the country.
Build communities of recovery- The bill authorizes $200 million annually to build connections between treatment programs, mental health providers, treatment systems, and other recovery supports. This includes training and dissemination of naloxone, the lifesaving medication designed to rapidly reverse opioid overdose. Public education campaigns will also be used to reduce the stigma associated with substance use disorders.
Credit: Shatterproof.org for the above summary on CARA 2.0 By putting limits on prescribers to dispense only a 3-day supply to patients will help tremendously with the epidemic. Opioids have a strong effect and it has been know that a person will become addicted after 3 days of using the narcotic. The problem in the past is that patients could go to different doctors and get a new prescription; this is commonly referred to as doctor shopping. Traditionally, large pharmaceutical companies send reps to doctors’ offices and push their products, which made the physicians prescribe more pills, resulting in patients becoming addicted.
Our first responders are the first crucial step when it comes to being able to save someone’s life from an overdose. I am pleased that this bill will provide funding to train and educate first responders on how to deal with Fentanyl and help them to be able to save as many lives as possible.
The recovery community is very broad and can help someone who is new to recovery stay in long-term recovery.Providing the necessary funding for the recovery community is vital and it will save so many lives. I personally feel the only best way to slow this epidemic down is by breaking the stigma, tell your story, and model your recovery so it will give hope to others. To join in the fight and add your voice to the fight for this bill, please visit CARA 2.0 Call to Action
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